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Risk of methicillin-resistant staphylococcus aureus prosthetic joint infection in elective total hip and knee
Benjamin Pal Kapur1, Xenia Tonge2, Gunasekaran Kumar2
1Trauma and Orthopaedics, Royal Liverpool University Teaching Hospitals, Liverpool L7 8XP, Merseyside, United Kingdom. benjaminkapur@nhs.net.
Background:
Prosthetic joint infection (PJI) is a devastating complication requiring prolonged treatment and multiple operations, leading to significant morbidity for the patient. Patients are routinely tested for methicillin-resistant staphylococcus aureus (MRSA) colonisation. MRSA positive patients are given eradication therapy. We hypothesise that patients who are MRSA positive pre-operatively, have increased risk of developing PJI.
Aim:
To identify deep wound infection (PJI) rates in patients who are colonised MRSA positive compared with those who are not colonised; and long term clinical and radiological outcomes.
Methods:
All patients who underwent total hip and knee replacements (THR/TKR) between December 2009 and December 2019 were identified. Patients who were also identified as being MRSA positive at pre-operative assessment were then selected. Confirmation of prescribing eradication treatment was recorded. Patient records, including consultation letters, operation notes and microbiology results were reviewed retrospectively. Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.
Results:
Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive, 84 MRSA negative knee and 64 hip patients were reviewed. Patients were matched with medical co-morbidities in each group. Mean follow up was 5 years. PJI was identified in 4/32 (12.5%) of THR MRSA positive and 3/42 (7%) of TKR patients. All patients had PJI within one year of surgery.
Conclusion:
MRSA positive patients are given eradication therapy routinely. However, no confirmation of eradication is sought. Patients who have MRSA colonisation pre-operatively, in our study had a significantly increased risk of PJI, when compared to negative patients. We would recommend establishing true eradication after treatment prior to arthroplasty.
Insights
Pre-operative methicillin-resistant staphylococcus aureus (MRSA) colonization significantly increases the risk of prosthetic joint infection (PJI) after hip and knee replacements. Confirming MRSA eradication post-treatment is crucial to prevent PJI.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Microbiology
Background:
- Prosthetic joint infection (PJI) is a severe complication following joint replacement surgery.
- Routine screening for methicillin-resistant staphylococcus aureus (MRSA) colonization is performed, with eradication therapy for positive cases.
- The study investigates the hypothesis that pre-operative MRSA colonization elevates PJI risk.
Purpose of the Study:
- To compare deep wound infection (PJI) rates in MRSA-colonized versus non-colonized patients undergoing arthroplasty.
- To evaluate long-term clinical and radiological outcomes in these patient groups.
Main Methods:
- Retrospective review of total hip and knee replacement (THR/TKR) patients from December 2009 to December 2019.
- Identification and selection of MRSA-positive patients who received pre-operative eradication therapy.
- Matching MRSA-positive cases with two MRSA-negative controls for comparison of outcomes.
Main Results:
- The study included 74 MRSA-positive (32 hip, 42 knee) and 148 MRSA-negative patients.
- Mean follow-up was 5 years.
- PJI occurred in 12.5% of MRSA-positive THR patients and 7% of MRSA-positive TKR patients, all within one year of surgery.
Conclusions:
- Pre-operative MRSA colonization is associated with a significantly higher risk of PJI compared to MRSA-negative patients.
- Current eradication therapy protocols lack confirmation of successful eradication.
- Establishing confirmed MRSA eradication post-treatment is recommended before arthroplasty to mitigate PJI risk.
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